Basic Information
| Provider Information | |||||||||
| NPI: | 1093347221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COMBS | ||||||||
| FirstName: | ELEANOR | ||||||||
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| Credential: | AGNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 SW LONGVIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640812103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772795960 | ||||||||
| FaxNumber: | 7378431121 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 BERNARD DR | ||||||||
| Address2: | |||||||||
| City: | BELTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640126185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163317848 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2020 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2019024686 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LG0600X | 2019024686 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.